A Prospective Survey of Atrial Fibrillation Management for Real-world Guideline Adherence: COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation (CODE-AF) Registry.
- Author:
Hyeongsoo KIM
1
;
Tae Hoon KIM
;
Myung Jin CHA
;
Jung Myung LEE
;
Junbeom PARK
;
Jin Kyu PARK
;
Ki Woon KANG
;
Jaemin SHIM
;
Jae Sun UHM
;
Jun KIM
;
Hyung Wook PARK
;
Eue Keun CHOI
;
Jin Bae KIM
;
Changsoo KIM
;
Young Soo LEE
;
Boyoung JOUNG
Author Information
- Publication Type:Original Article
- Keywords: Atrial fibrillation; Anticoagulant agent; Guidelines adherence; Registry
- MeSH: Aging; Asia; Atrial Fibrillation*; Calcium Channels; Digoxin; Guideline Adherence*; Heart Diseases; Humans; Korea; Prospective Studies*; Public Health; Sotalol; Stroke; Tertiary Care Centers
- From:Korean Circulation Journal 2017;47(6):877-887
- CountryRepublic of Korea
- Language:English
- Abstract: BACKGROUND AND OBJECTIVES: The aging population is rapidly increasing, and atrial fibrillation (AF) is becoming a significant public health burden in Asia, including Korea. This study evaluated current treatment patterns and guideline adherence of AF treatment. METHODS: In a prospective observational registry (COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation [CODE-AF] registry), 6,275 patients with nonvalvular AF were consecutively enrolled between June 2016 and April 2017 from 10 tertiary hospitals in Korea. RESULTS: The AF type was paroxysmal, persistent, and permanent in 65.3%, 30.0%, and 2.9% of patients, respectively. Underlying structural heart disease was present in 11.9%. Mean CHA2DS2-VASc was 2.7±1.7. Oral anticoagulation (OAC), rate control, and rhythm control were used in 70.1%, 53.9%, and 54.4% of patients, respectively. OAC was performed in 82.7% of patients with a high stroke risk. However, antithrombotic therapy was inadequately used in 53.4% of patients with a low stroke risk. For rate control in 192 patients with low ejection fraction (< 40%), β-blocker (65.6%), digoxin (5.2%), or both (19.3%) were adequately used in 90.1% of patients; however, a calcium channel blocker was inadequately used in 9.9%. A rhythm control strategy was chosen in 54.4% of patients. The prescribing rate of class Ic antiarrythmics, dronedarone, and sotalol was 16.9% of patients with low ejection fraction. CONCLUSION: This study shows how successfully guidelines can be applied in the real world. The nonadherence rate was 17.2%, 9.9%, and 22.4% for stroke prevention, rate control, and rhythm control, respectively.
